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The mission of the Veterans Health Administration's (VHA) quality enhancement research initiative (QUERI) is to enhance the quality of VHA health care by implementing clinical research findings into routine care. This paper presents lessons that QUERI investigators have learned through their initial attempts to pursue the QUERI mission. The lessons in this paper represent those that were common across multiple QUERI projects and were mutually agreed on as having substantial impact on the success of implementation. While the lessons are consistent with commonly recognized ingredients of successful implementation efforts, the examples highlight the fact that, even with a thorough knowledge of the literature and thoughtful planning, unexpected circumstances arise during implementation efforts that require flexibility and adaptability. The findings stress the importance of utilizing formative evaluation techniques to identify barriers to successful implementation and strategies to address these barriers. [ABSTRACT FROM AUTHOR]

This paper addresses two seeming paradoxes in the realm of employer-provided health insurance: First, businesses consistently claim that they bear the burden of the insurance they provide for employees, despite theory and empirical evidence indicating that workers bear the full incidence. Second, benefit generosity and the percentage of premiums paid by employers have decreased in recent decades, despite the preferential tax treatment of employer-paid benefits relative to wages-trends unexplained by the standard incidence model. This paper offers a revised incidence model based on nominal wage rigidity, in an attempt to explain these paradoxes. The model predicts that when the nominal wage constraint binds, some of the burden of increasing insurance premiums will fall on firms, particularly small companies with low-wage employees. In response, firms will reduce employment, decrease benefit generosity, and require larger employee premium contributions. Using Current Population Survey data from 2000-2001, I find evidence for this kind of wage rigidity and its associated impact on the employment and premium contributions of low-wage insured workers during a period of rapid premium growth. [ABSTRACT FROM AUTHOR]

This paper examines the effects of conversions between For-Profit and Not-For-Profit forms on quality of medical care in California hospitals. The sample includes elderly patients treated in California's private hospitals from 1990 to 1998 for Acute Myocardial Infarction and Congestive Heart Failure. The results suggest that converted hospitals have experienced quality changes before conversion and that ignoring these changes may bias the estimates of conversion effects. Both conversions are found to have some adverse consequences: Hospitals that converted to FP form show an increase in AMI mortality rates, while those converted to NFP status indicate an increase in CHF mortality outcomes. [ABSTRACT FROM AUTHOR]

Childbearing motivation may be conceptualized as based upon psychological traits and shaped by experiences during childhood, adolescence, and early adult life. This paper explores what those traits and developmental experiences are. Two measures of childbearing motivation, one positive and the other negative, are described. Using a sample of 362 married men and 354 married women, the paper systematically examines the factors associated with these measures. In addition to a set of basic personality traits, these factors include parental characteristics, teenage experiences, and a number of variables from young adult behavior domains such as marriage, education, work, religion, and parental relationships. Stepwise multiple regression analyses lead to two final constrained, simultaneous-equation regression models. These models indicate the importance of both personality traits and diverse life-cycle experiences in the development of childbearing motivation, the differential gender distribution of predictors, and the different experiential antecedents of positive and negative motivation. [ABSTRACT FROM AUTHOR]

This paper examines the relation between unmarried cohabitation and three important determinants of fertility-frequency of sexual intercourse, contraceptive practice, and the expectation to have a child within five years. Analyses based on data from the 1982 National Survey of Family Growth show that formerly married cohabitants are similar to married women with respect to these fertility determinants, but that never married cohabitants may have lower fertility in the short run because of extremely high levels of contraceptive practice. The paper also compares self-reported data on cohabitation with an inferred measure based on household composition. [ABSTRACT FROM AUTHOR]

This paper discusses recent migration to North America with reference to the 1962 and 1967 Canadian immigration regulations and the 1965 United States Immigration and Nationality Act. Despite the similar emphasis on manpower and kinship criteria as the basis for the admission of immigrants, differences between Canada and the United States exist with respect to the importance of immigration for the respective economies, the organization of immigration, the formal regulations, and the size and composition of migrant streams. After an examination of the volume, origin, and occupational composition of immigration to Canada and the United States, flows between the two countries are studied. The paper concludes with a scrutiny of changes in immigration regulations which are pending in both countries. [ABSTRACT FROM AUTHOR]

Delivering well-coordinated care is essential for optimizing clinical outcomes, enhancing patient care experiences, minimizing costs, and increasing provider satisfaction. The Veterans Health Administration (VA) has built a strong foundation for internally coordinating care. However, VA faces mounting internal care coordination challenges due to growth in the number of Veterans using VA care, high complexity in Veterans' care needs, the breadth and depth of VA services, and increasing use of virtual care. VA's Health Services Research and Development service with the Office of Research and Development held a conference assessing the state-of-the-art (SOTA) on care coordination. One workgroup within the SOTA focused on coordination between VA providers for high-need Veterans, including (1) Veterans with multiple chronic conditions; (2) Veterans with high-intensity, focused, specialty care needs; (3) Veterans experiencing care transitions; (4) Veterans with severe mental illness; (5) and Veterans with homelessness and/or substance use disorders. We report on this workgroup's recommendations for policy and organizational initiatives and identify questions for further research. Recommendations from a separate workgroup on coordinating VA and non-VA care are contained in a companion paper. Leaders from research, clinical services, and VA policy will need to partner closely as they develop, implement, assess, and spread effective practices if VA is to fully realize its potential for delivering highly coordinated care to every Veteran. [ABSTRACT FROM AUTHOR]

This perspective paper seeks to lay out an efficient approach for health care providers, researchers, and other stakeholders involved in interventions aimed at improving care coordination to partner in locating and using applicable care coordination theory. The objective is to learn from relevant theory-based literature about fit between intervention options and coordination needs, thereby bringing insights from theory to enhance intervention design, implementation, and troubleshooting. To take this idea from an abstract notion to tangible application, our workgroup on models and measures from the Veterans Health Administration (VA) State of the Art (SOTA) conference on care coordination first summarizes our distillation of care coordination theoretical frameworks (models) into three common conceptual domains-context of an intervention, locus in which an intervention is applied, and specific design features of the intervention. Then we apply these three conceptual domains to four cases of care coordination interventions ("use cases") chosen to represent various scopes and stages of interventions to improve care coordination for veterans. Taken together, these examples make theory more accessible and practical by demonstrating how it can be applied to specific cases. Drawing from theory offers one method to anticipate which intervention options match a particular coordination situation. [ABSTRACT FROM AUTHOR]

Background: Improving care coordination is a key priority for many healthcare systems. However, initiatives to improve care coordination are complex to implement and have produced mixed results. A better understanding of how to craft and support implementation of effective care coordination strategies is needed.Objective: To identify and understand the challenges and factors encountered by Patient-Aligned Care Team (PACT) staff in performing care coordination tasks in outpatient clinics in the Veterans Health Administration (VA).Design: Qualitative study using semi-structured formative evaluation interviews.Participants: Fourteen interviews with 18 clinical frontline managers and staff from 12 clinic sites across five VA health systems.Interventions: This paper reports on baseline data collected for the Coordination Toolkit and Coaching (CTAC) project. CTAC aims to improve patients' experience of care coordination within VA primary care and between PACT and other outpatient and community settings.Approach: We conducted pre-implementation telephone interviews with frontline managers and staff, primarily nurse managers.Key Results: PACT staff described challenges in aligning care coordination priorities across different levels of the VA system, including staff, patients, and leadership. Additionally, PACT staff noted challenges coordinating care both within and outside the VA, and identified resource barriers impeding their care coordination efforts. To address these challenges, staff made several recommendations for improvement, including (1) contingency staffing to address staff burnout; (2) additional PACT training for new staff; (3) clarification of care coordination roles and responsibilities; and (4) and care coordination initiatives that align both with centrally initiated care coordination programs and frontline needs.Conclusion: In the VA and similarly complex healthcare systems, our findings suggest the need for care coordination strategies that are buttressed by a system-level vision for care coordination, backed up by clear roles and responsibilities for information exchange between primary care staff and other settings, and multidimensional accountability metrics that encompass patient-, staff-, and system-level goals. [ABSTRACT FROM AUTHOR]

6–11-year-old children provide a critical window for physical activity (PA) interventions. The Virtual Fitness Buddy ecosystem is a precision health PA intervention for children integrating mixed reality technology to connect people and devices. A cluster randomized, controlled trial was conducted across 19 afterschool sites over two 6-month cohorts to test its efficacy in increasing PA and decreasing sedentary behavior. In the treatment group, a custom virtual dog via a mixed reality kiosk helped children set PA goals while sharing progress with parents to receive feedback and support. Children in the control group set PA goals using a computer without support from the virtual dog or parents. 303 children had 8+ hours of PA data on at least one day of each of the 3 intervention time intervals. Conversion of sedentary time was primarily to light-intensity PA and was strongest for children with low baseline moderate-to-vigorous PA than children above 45 min of baseline moderate-to-vigorous PA. Findings suggest that the VFB ecosystem can promote sustainable PA in children and may be rapidly diffused for widespread public health impact. [ABSTRACT FROM AUTHOR]

Racial-ethnic minorities receive lower quality and intensity of health care compared with whites across a wide range of preventive, diagnostic, and therapeutic services and disease entities. These disparities in health care contribute to continuing racial-ethnic disparities in the burden of illness and death. Several national medical organizations and the Institute of Medicine have issued position papers and recommendations for the elimination of health care disparities. However, physicians in practice are often at a loss for how to translate these principles and recommendations into specific interventions in their own clinical practices. This paper serves as a blueprint for translating principles for the elimination of racial-ethnic disparities in health care into specific actions that are relevant for individual clinical practices. We describe what is known about reducing racial-ethnic disparities in clinical practice and make recommendations for how clinician leaders can apply this evidence to transform their own practices. [ABSTRACT FROM AUTHOR]

The Examining Community-Institutional Partnerships for Prevention Research Project began in October 2002 with funding from the Centers for Disease Control and Prevention Research Center Program Office through a cooperative agreement between the Association of Schools of Public Health and the CDC. The three-year project aimed to synthesize knowledge about community-institutional partnerships for prevention research and to build community and institutional capacity for participatory research. These ten organizations collaborated on the project because they were all involved in community-institutional partnerships for prevention research, had access to research and evaluation data on these partnerships, and believed that the shared learning and action that would result through a collaborative effort could significantly advance collective knowledge about partnerships and lead to substantive capacity-building responses: the Community Health Scholars Program, Community-Based Public Health Caucus of the American Public Health Association, Community-Campus Partnerships for Health, Detroit Community-Academic Urban Research Center, Harlem Health Promotion Center, National Community Committee of the CDC Prevention Research Centers Program, New York Urban Research Center, Seattle Partners for Healthy Communities, Yale-Griffin Prevention Research Center and the Wellesley Institute. This paper reports on the project's findings, including common characteristics of successful partnerships and recommendations for strengthening emerging and established partnerships. [ABSTRACT FROM AUTHOR]

In this paper, we have traced changes in the patterns of first marriage in the United States for cohorts of men and women born in 1880 through 1965 and for the years from 1900 through 1983. There were striking changes in marriage rates associated with each of the world wars and with the depression of the 1930s. In addition to these short-term fluctuations, a long-term shift in marriage rates is observed over the period from after World War II until about 1970. By the end of the 1970s, however, marriage rates had returned to levels similar to those observed before the war. The basic similarity in the timing of changes in marriage rates across age levels and for both men and women, blacks and whites, is a striking characteristic of these marriage curves. There are also, however, important differences among these groups with respect to the magnitude and slopes of the shifts. The postwar marriage boom was strongest among the young (those under age 24) and among whites. Similarly, the declines in marriage rates observed in the 1970s were greatest among the young. The marriage rates for teenagers display trends that diverge in many respects from those of older persons. For example, the marriage rates of male teenagers did not show the "peaks" and "valley" associated with World War II for older age groups and female teenagers. Moreover, there is little sign of the postwar marriage boom among black teenagers of either sex. Indeed, the marriage rates of black teenagers began to decline soon after the war, and by the 1970s the marriage rates of both male and female black teenagers had fallen below those of their white counterparts, reversing the pattern that had existed through the first half of this century. During the twenty-five or so years of the postwar marriage boom, which we believe can be characterized best as a period phenomenon, there were trends-eddies within the mainstream-which are probably most easily interpreted as the consequence of a cohort effect.(ABSTRACT TRUNCATED AT 400 WORDS) [ABSTRACT FROM AUTHOR]

Many theories of geographic mobility assume that the change-of-residence process includes a substantial degree of choice. This paper classifies stated reasons for moving from the 1973 through 1977 Annual Housing Survey into forced, imposed, and preference-dominated categories. About 25 percent of residential mobility and 40 percent of migration occurred under conditions of substantial constraint. Mobility was most often constrained by family dynamics; for migration, occupational relocations frequently imposed the decision-to-move process and determined destinations. The volume of constrained movement indicates that its impact upon individuals, population dynamics, and voluntaristic theories of mobility deserves greater consideration. [ABSTRACT FROM AUTHOR]

This paper analyzes cross-cohort trends in the age pattern of women at first birth in the United States. The analysis involves fitting the Coale-McNeil marriage model to the age distribution of first birth frequencies for a number of recent white and nonwhite cohorts. Methodologically, the results (a) provide support for the application of the Coale-McNeil marriage model to first birth data, and (b) demonstrate the ability of the model to accurately project first birth fertility for cohorts which have yet to complete their childbearing years. Substantively the results indicate (a) that the proportion of women who will never have a first birth is increasing across cohorts and can be expected to be as high as .25 and .20 for recent white and nonwhite cohorts respectively; (b) that recent nonwhite cohorts have an appreciable number of first births at earlier ages than their white counterparts, as well as a lower mean age at first birth and increasingly less dispersion (across cohorts) in their age at first birth; and (c) that the mean age at first birth and the proportion of first births occurring between ages 25 and 34 is increasing across cohorts of white women but is stable across cohorts of nonwhite women. [ABSTRACT FROM AUTHOR]

Recent work with samples of black and white urban American women showed a clear behavioral sequence relating age at menarche to age at first intercourse to age at first birth. This paper shows that the linking of ages at menarche, intercourse, marriage, and first birth is a pattern which occurs in very diverse cultures. We present confirmatory data from the United States, Belgium, and Pakistan, and from Malay and Chinese women in Malaysia. We interpret our findings as indicating a biological process leading to (a) social interpretations of readiness for reproduction, and (b) persisting biological differences between early and late maturing women. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to shed light on the causes of the rapid decline in the infant mortality rate in the United States in the period after 1963. The roles of four public policies are considered: Medicaid, subsidized family planning services for low-income women, maternal and infant care projects, and the legalization of abortion. The most striking finding is that the increase in the legal abortion rate is the single most important factor in reductions in both white and nonwhite neonatal mortality rates. Not only does the growth in abortion dominate the other public policies, but it also dominates schooling and poverty. [ABSTRACT FROM AUTHOR]

This paper examines determinants of timing of marriage for young women by modeling the transition from the single to the married state by age. This approach, combined with a large longitudinal data set, allows us to disaggregate the analysis into fine age groupings and to include situational and attitudinal factors in our model. We find that those characteristics of a young woman's parental family that reflect the availability of parental resources tend to decrease the chances of a marriage during the early teens. Chances of marrying appear to decrease with increases in the availability and attractiveness of alternatives to the wife role and in the costs of assuming it. We discuss these results from the perspective of the societal and parental normative pressures which affect timing of marriage for young women. [ABSTRACT FROM AUTHOR]

While births may be dichotomous, fertility intentions are not inherently so. Intentions are predictions about the future and, as such, are couched in considerable uncertainty. Ignoring this uncertainty hides much of what could be learned from data on fertility intentions. This paper presents a model which allows analysis of the full range of intentions. This paper presents a model which allows analysis of the full range of intentions. After selecting a sample of women in the later stage of childbearing (e.g., those who intend fewer than two additional children) from the 1965 and 1970 National Fertility Studies, it is shown that: (1) substantial portions of women at this stage of the reproductive life cycle were indeed uncertain of their parity-specific intention; (2) this certainty, like more firm intentions, varies by age and parity as the model predicts; and (3) there were significant shifts in the level of certainty between 1965 and 1970. Specifically, while intentions for third, fourth, and fifth births declined, more women "didn't know" if they intended to have another child or not. Among those not intending another child, more seemed uncertain of this intention in 1970 than did comparable women in 1965. In contrast, those intending another child seemed more certain. These changes in intention and uncertainty indicate that the observed decline in intended parity was tentative. Post-1970 evidence suggests that this tentative decline has become an equivocal one. [ABSTRACT FROM AUTHOR]

This paper introduces an analytic framework that can be used to assess the relationships between individual movement differentials and place characteristics, on the one hand, and aggregate mobility levels and city-suburb population change (in size or composition), on the other. Application of this framework using census data for individual metropolitan areas allows the analyst to decompose population changes due to net migration into contributing mobility streams and their component rates which are subject to unique community and individual influences. The paper provides both theoretical and empirical rationale for the framework, illustrates its use with 1970 census data, and discusses its implications for empirical research on city-suburb population redistribution. [ABSTRACT FROM AUTHOR]

This paper applies the techniques of multiple decrement life tables to marriage histories collected as part of the 1973 National Survey of Family Growth, in an attempt to examine differences in pattern and level of marriage dissolution by marriage order. The paper considers the process of marriage dissolution in two stages--marriage to separation and separation to divorce--in addition to considering the composite of these two, marriage to divorce. Second marriages are more likely to reamin intact only for blacks. For all subgroups of whites, second marriages are either as likely or more likely to dissolve than first marriages. For both first and second marriages, blacks are considerably less likely to obtain a divorce after separation. [ABSTRACT FROM AUTHOR]

The After Breast Cancer Pooling Project was established to examine the role of physical activity, adiposity, dietary factors, supplement use, and quality of life (QOL) in breast cancer prognosis. This paper presents pooled and harmonized data on post-diagnosis lifestyle factors, clinical prognostic factors, and breast cancer outcomes from four prospective cohorts of breast cancer survivors (three US-based and one from Shanghai, China) for 18,314 invasive breast cancer cases diagnosed between 1976 and 2006. Most participants were diagnosed with stage I-II breast cancer (84.7%). About 60% of breast tumors were estrogen receptor (ER)+/progesterone receptor (PR)+; 21% were ER-/PR-. Among 8,118 participants with information on HER-2 tumor status, 74.8% were HER-2- and 18.5% were HER-2+. At 1-2 years post-diagnosis (on average), 17.9% of participants were obese (BMI ≥ 30 kg/m2), 32.6% were overweight (BMI 25-29 kg/m2), and 59.9% met the 2008 Physical Activity Guidelines for Americans (≥ 2.5 h per week of moderate activity). During follow-up (mean = 8.4 years), 3,736 deaths (2,614 from breast cancer) and 3,564 recurrences have been documented. After accounting for differences in year of diagnosis and timing of post-diagnosis enrollment, five-year overall survival estimates were similar across cohorts. This pooling project of 18,000 breast cancer survivors enables the evaluation of associations of post-diagnosis lifestyle factors, QOL, and breast cancer outcomes with an adequate sample size for investigation of heterogeneity by hormone receptor status and other clinical predictors. The project sets the stage for international collaborations for the investigation of modifiable predictors for breast cancer outcomes. [ABSTRACT FROM AUTHOR]

The article discusses studies on chronic pain selected by the members of the Society of General Internal Medicine. It says that the papers were chosen for their potential to change generalist care of patients with chronic pain. The articles include one on the assessment of pain intensity and interference, a randomized trial on optimized antidepressant therapy and pain self-management to improve pain and depression outcomes, and one on the trends in opioid use in patients with non-cancer pain.

In recent decades, rapid growth of the U.S. Hispanic population has raised concerns about immigrant adaptation, including fertility. Empirical research suggests that Hispanics, especially Mexicans, might not be following the historical European pattern of rapid intergenerational fertility decline (and convergence toward native levels). If confirmed, continued high Hispanic fertility could indicate a broader lack of assimilation into mainstream American society. In this paper, we reexamine the issue of Hispanic and Mexican fertility using an approach that combines biological and immigrant generations to more closely approximate a comparison of immigrant women with those of their daughters' and granddaughters' generation. Contrary to cross-sectional results, our new analyses show that Hispanic and Mexican fertility is converging with that of whites, and that it is similarly responsive to period conditions and to women's level of education. In addition, we employ a mathematical simulation to illustrate the conditions under which cross-sectional analyses can produce misleading results. Finally, we discuss the import of the fertility convergence we document for debates about immigrant assimilation. [ABSTRACT FROM AUTHOR]

The expansion of women in the military is reshaping the veteran population, with women now constituting the fastest growing segment of eligible VA health care users. In recognition of the changing demographics and special health care needs of women, the VA Office of Research & Development recently sponsored the first national VA Women's Health Research Agenda-setting conference to map research priorities to the needs of women veterans and position VA as a national leader in Women's Health Research. This paper summarizes the process and outcomes of this effort, outlining VA's research priorities for biomedical, clinical, rehabilitation, and health services research. [ABSTRACT FROM AUTHOR]

The U.S. health care system is one of the world's most advanced systems. Yet, the health care system suffers from unexplained practice variations, major gaps between evidence and practice, and suboptimal quality. Although information processing, communication, and management are key to health care delivery and considerable evidence links information/communication technology (IT) to improvements in patient safety and quality of care, the health care system has a longstanding gap in its investment. In the Crossing the Quality Chasm and Building a Better Delivery System reports, The Institute of Medicine and National Academy of Engineering identified IT integration as critical to improving health care delivery systems. This paper reviews the state of IT use in the U.S. health care system, its role in facilitating evidence-based practices, and identifies key attributes of an ideal IT infrastructure and issues surrounding IT implementation. We also examine structural, financial, policy-related, cultural, and organizational barriers to IT implementation for evidence-based practice and strategies to overcome them. [ABSTRACT FROM AUTHOR]

While great strides have been made recently in improving end-of-life care in the United States, people with dementia often die with inadequate pain control, with feeding tubes in place, and without the benefits of hospice care. In this paper, we discuss the most important and persistent challenges to providing excellent end-of-life care for patients with dementia, including dementia not being viewed as a terminal illness; the nature of the course and treatment decisions in advanced dementia; assessment and management of symptoms; the caregiver experience and bereavement; and health systems issues. We suggest approaches for overcoming these barriers in the domains of education, clinical practice, and public policy. As the population ages, general internists increasingly will be called upon to provide primary care for a growing number of patients dying with dementia. There are great opportunities to improve end-of-life care for this vulnerable and underserved population. [ABSTRACT FROM AUTHOR]

Objectives: Oral epithelial dysplasia (OED) is a histopathologic diagnosis associated with an increased risk of oral cancer. The paper explores the relationship between OED risk and food group intake.Methods: In this case-control study, incident cases of OED were identified through two oral pathology laboratories. Controls, pair-matched 1:1 to cases on age (+/- 5 years), gender, appointment date (+/- 1 year), and surgeon, were identified through the office in which the respective case was biopsied. Exposure data were obtained via a telephone interview and mailed food-frequency questionnaire. Conditional logistic regression was used to obtain odds ratio point estimates.Results: Based upon 87 matched pairs and after controlling for smoking, drinking, and other potential covariates there was an apparent inverse relationship between OED risk and the consumption of fruits and vegetables, with the intake of these foods being associated with a strong attenuating effect among smokers. OED risk decreased with increased poultry consumption, but increased modestly with bread/cereal and dairy food intake.Conclusions: This investigation provides evidence that some aspects of diet may be associated with the risk of OED. It also suggests that in oral carcinogenesis the role of diet is not simply one of a late effect. [ABSTRACT FROM AUTHOR]

Prior presentations: None INTRODUCTION The epidemic of burnout among clinicians is well documented[1]. We examined burnout among all team members using data from a project on impact of payment reform on safety net health care clinicians, staff, and patients. Burnout: 1 = not burned out, 5 = very burned out * I p i <.05 DISCUSSION Among staff and clinicians in three safety net clinics, we found a wide range of burnout, from 12.5 to 87.5%. [Extracted from the article]

In this paper, queuing theory is tested through an examination of the occupational attainment of six groups of non-whites in London and New York. Workers in the dominant economy are distinguished from those in the niche economy and emphasis is placed on the former. Black male immigrants in New York and black female immigrants in London hold more favorable occupational status. These results reflect differences in (1) the presence of indigenous minorities--African Americans and Puerto Ricans--in New York but not London, and (2) the relatively low position of indigenous minority males compared to the relatively middling position of indigenous minority females in New York's labor queue. [ABSTRACT FROM AUTHOR]

The growing study of leaving home in young adulthood in the United States has been hampered by data and measurement problems, which are producing a major theoretical confusion about the role of parental resources in influencing young adults' leaving home. Does high parental income retain young adults in the home or subsidize their leaving (and parental privacy)? This paper uses the 1984 panel of Survey of Income and Program Participation to clarify this issue, and shows that the effects of parental resources differ depending on the route out of the home under consideration (marriage or premarital residential independence). Effects change substantially over the nest-leaving ages, but relatively few differences are found between young men and young women. [ABSTRACT FROM AUTHOR]

This paper examines the ways in which the behavior of twentieth century cohorts of American women changed simultaneously in the three components of fertility that determine age at last birth--age at first birth, spacing between subsequent births, and parity progression ratios of subsequent births--to produce changes in the timing of the completion of childbearing. It decomposes changes in the mean age at last birth among cohorts and between whites and nonwhites to changes in these three components. To perform these analyses, we developed and applied a method to estimate the distributions and means of ages and last births, birth intervals, and parity progression ratios from age- and parity-specific fertility rates available from vital statistics data. Results show that the cohorts increased and decreased their age at first birth, birth intervals, and parity progression ratios of lower and higher birth orders in almost every possible combination so as to achieve a relatively young age at final birth. [ABSTRACT FROM AUTHOR]

We use vital registration data published since 1979 to update trends in the timing of first births. Two important trends are documented. First, the likelihood that childless women over age 30 will have a first birth has increased since the 1970s. This change shows that women born in the 1950s are "catching up" on fertility postponed at younger ages. Second, racial differences in the timing of first births are very large. For those born in the 1950s, nonwhites have first births much earlier, and far fewer nonwhite than white women will remain permanently childless. In the second part of the paper, we use these data for recent years to assess earlier projections of childlessness based on cohort and period approaches. We also assess the accuracy of stated intentions to have no children. [ABSTRACT FROM AUTHOR]

This paper is an empirical exploration of the effects of a variety of family and economic circumstances experienced during childhood on one indicator of success in young adulthood--high school completion. The estimates suggest that parental education and mother's work are positive and significant determinants of high school completion, whereas growing up in a family with more children (who compete for resources), being persistently poor and on welfare, and moving one's residence as a child have significant negative impacts on high school completion. The effects of some family stress and economic events differ depending on the age of the child when they occur. The results support the economic model of investment in children, as well as the welfare culture and socialization models. [ABSTRACT FROM AUTHOR]

A detailed record of the number and characteristics of persons in poverty is available since 1959. This paper provides measures for 1939 and 1949 that correspond as closely as possible to the official poverty statistics. Poverty, as officially measured, fell from 40.5 percent of all persons in 1949 to 13.1 percent in 1979, declining most among the elderly and least among female-headed households. We estimate the effects on the aggregate poverty rate of changes between 1940 and 1980 in the distribution of the population by selected demographic characteristics of household heads and by the employment status of head and spouse. Some changes, such as the increasing proportion of two-earner families, were poverty reducing, whereas others were poverty increasing. [ABSTRACT FROM AUTHOR]

This paper examines the probabilities of first marriage dissolution in Canada, using the marital history data collected from a national sample of women in their reproductive years. It is found that age at marriage, year of marriage, cohabitation before marriage, a premarital birth or conception, urban-rural place of residence, and religiosity are all significantly correlated with marriage dissolution. Religion and education, on the other hand, do not seem to affect the marriage dissolution probabilities when other factors are controlled. Canadian patterns are not too different from patterns in the United States. [ABSTRACT FROM AUTHOR]

This paper examines relationships among six social factors and infant mortality in California in 1978 and seeks to explain social differentials in terms of two intervening variables. Linked birth and infant death records are analyzed to test for interactions among the social factors and mortality and for causal linkages involving the intervening variables. Social factors are related to the risk of infant mortality in a conditional manner; significant interactions involve maternal age and both birth order and marital status, and race/ethnicity and both education and marital status. Birth weight and prenatal care are important intervening variables but do not fully explain the social differentials. [ABSTRACT FROM AUTHOR]

This paper examines the impact of induced abortion on birth outcomes by treating abortion as an endogenous input into the production of infant health. To gauge the direct and indirect effects of abortion, three measures of infant health are considered simultaneously: the neonatal mortality rate, the percentage of low-weight births, and the percentage of preterm births. All three are race specific and all pertain to large counties in the United States in 1977. The results suggest that by preventing unwanted births, abortion enhances the survivability of newborns of a given birth weight and improves the distribution of births among high-risk groups. [ABSTRACT FROM AUTHOR]

This paper examines the influence of individual development and historical change on marital dissolution. Data from the vital statistics system of the United States and from the June 1980 Current Population Survey are used to examine the experience of marriage cohorts from 1905 through 1975 and the periods from 1922 through 1979. The historical patterns can best be explained as effects of period rather than of birth or marriage cohort, and the individual patterns can be explained best as effects of age and age at marriage rather than of marital duration. [ABSTRACT FROM AUTHOR]

By presenting race-specific population concentration indexes for U.S. counties for the 1950-1980 period, this paper updates and extends previous analyses of 1900-1974 patterns of population concentration by Duncan et al. (1961) and Vining and Strauss (1977). Declines in population concentration persisted through 1980 only among the white population. Blacks continued to experience increases in population concentration between 1970 and 1980. These racially divergent patterns of concentration in the 1970s have translated into increases in segregation between blacks and whites across U.S. counties. [ABSTRACT FROM AUTHOR]

The results reported here show that the stage of an individual's life cycle not only has direct effects on the likelihood of migration, but also establishes a context within which the motives to migrate are evaluated and acted upon. One contextual impact of the life cycle concerns the effects of length of residence on migration. The results show that the probability of migrating declines more rapidly over time for married males with children than for singles males--i.e., the difference between the likelihood of migration for single males and married males with children widens with increasing length of residence. Much of this difference may be due to the greater number and strength of community ties for individuals who are married with children. These ties are not well developed at the beginning of a residence but continue to strengthen over the course of a residence. In addition, there are variations in the levels of job rewards and location-specific resources across the life cycle and there are two variations across the early life cycle in the effects of independent variables on the initial rate of migration. One resource (self-employment) and one job reward (prestige) have different effects for single individuals than for either group of married males. If the span of the life cycle considered in this analysis were broadened to include older men, additional differences in the effects of independent variables might be uncovered. In research with cross-sectional data containing a wider range of ages than the data used here, Heaton et al. (1981) found that economic variables were more important in determining the migration of younger individuals than that of older individuals, whereas noneconomic factors were more important determinants of the migration of older than of younger individuals. The results of this paper and Heaton's results suggest that at different stages of life people use a somewhat different "subjective cost-benefit calculus" in making migration decisions. The importance of certain migration determinants may vary significantly depending on whether an individual is married, whether he or she has children, and/or whether he or she is in the labor force or retired. Additional research on these issues could greatly contribute to our understanding of migration. [ABSTRACT FROM AUTHOR]

This paper presents estimates of delayed childbearing and permanent childlessness in the United States and the determinants of those phenomena. The estimates are derived by fitting the Coale-McNeil marriage model to survey data on age at first birth and by letting the parameters of the model depend on covariates. Substantively, the results provide evidence that the low first birth fertility rates experienced in the 1970s were due to both delayed childbearing and to increasing levels of permanent childlessness. The results also indicate that (a) delayed childbearing is less prevalent among black women than among nonblack women; (b) education is an important determinant of delayed childbearing whose influence on this phenomenon seems to be increasing across cohorts; (c) education is positively associated with heterogeneity among women in their age at first birth; (d) the dispersion of age at first birth is increasing across cohorts; (e) race has an insignificant effect on childlessness; and (f) education is positively associated with childlessness, with the effect of education increasing and reaching strikingly high levels for the most recent cohorts. [ABSTRACT FROM AUTHOR]

This paper deals with the mismatch between occupation and schooling attainment, the imbalance between occupation-specific demand for labor and schooling-level-specific labor supply. A framework for measuring the prevalence of mismatch is given, and a simple index derived from it gives plausible results and robust inferences about differentials and time trend. This approach can be applied to existing data, yields comprehensive and current social indicators, and can be used with a minimum number of assumptions. Trends for the U.S. labor force over the 1969-1980 interval are examined. Results show that there has been a dramatic and general increase in mismatch prevalence. Various demographic explanations of mismatch trends are examined. [ABSTRACT FROM AUTHOR]

Most research on married women's labor force participation relates characteristics of individual women to their probability of labor force participation. Some studies relate characteristics of geographic areas to average labor force participation rates in those areas, although these aggregate level analyses are usually gross tests of ideas about individual-level processes. Here we take a quintessentially sociological perspective and seek to understand how characteristics of geographic areas structure the relationship between properties of individual women and their probabilities of labor force participation. Our analysis has two steps. In step one, we fit individual-level probit models of married women's probability of labor force participation. A separate model is fitted in each of 409 areas using 1970 Census data, and the relationship between individual characteristics and labor force participation is found to vary substantially across areas. In step two, we attempt to explain areal variation in the effects of women's children on their labor force participation. We hypothesize that the effect of children on their mothers' labor force participation is a function of the cost and availability of childcare , and of the "convenience" of jobs for working mothers in the places where the mothers live. Measures of childcare cost, childcare availability and job convenience are developed. Weighted least squares analyses of probit coefficients from the first stage are, in general, very consistent with our findings, and suggest that the approach taken in this paper is likely to be a fruitful one for future studies. [ABSTRACT FROM AUTHOR]

There was an increase from 62.8 to 79.1 million households in the United States during the 1970s. The number of households increased much more rapidly than the population. This paper decomposes this growth in the number of households into components associated with changing age and martial status composition and changing age by marital status-specific propensities to form households. About one-third of the increase in the number of households was due to increased age by marital status propensity to form households, and two-thirds was due to shifts in the age by marital status distribution and population growth. The increased propensity to form households had its major impact at ages under 35, and primarily among never-married persons. The composition component had its primary impact at ages 25-44 as a result of the baby boom, and also because of the increased fractions never married and separated and divorced. [ABSTRACT FROM AUTHOR]

This paper addresses the comparability of data from eight national fertility surveys conducted in the United States between 1955 and 1980. We examine the extent to which substantive conclusions about the levels and correlates of the timing of first birth vary across these data sources by comparing samples of women who were eligible to be included in more than one study. Results obtained from Ordinary Least Squares (OLS) and logistic regression analyses of several measures of timing indicate few study effects. Thus findings based on data from one survey can be replicated with comparable data from another. One notable exception is the relationship between contraceptive use prior to the first birth and the timing of that birth. The contraceptive variable appears to be poorly measured, leading to unstable estimates of the relationship. In general, our results suggest: (1) the feasibility of pooling data from the various surveys when modeling delayed childbearing; and (2) reasonable accuracy in assessing trends in the timing of first birth from multiple data sources. [ABSTRACT FROM AUTHOR]

Contemporary populations frequently space the births of children, and also attempt to stop childbearing after achieving a desired family size. While stopping behavior was evident in European populations in the late nineteenth century, little is known about the degree to which they attempted to space their children at specific interval lengths. This paper compares spacing patterns among various groups of white U.S. women in 1900, who were distinguished by varying family sizes and levels of fertility control. On the whole, there is little evidence of childspacing differences among native white populations, except for some very low parity women. The findings support the continued analysis of age patterns of fertility as the major means for determining the onset of conscious family limitation. [ABSTRACT FROM AUTHOR]

Among the various types of mortality, motor vehicle fatalities (MVF) and suicides are two that are very responsive to social, economic, and psychological factors. The analysis of the temporal patterns of suicides and MVF points to important but neglected forces affecting them. This paper examines the daily patterns of MVF and suicides for the United States from 1972 to 1976. The effects of the day of the week, month, year, and holidays on these types of mortality are estimated. Total MVF and suicides, as well as daily differentials by sex, age, and race, are analyzed with regression techniques. The results show that temporal variations are stronger in MVF than in suicides but are present in both. MVF tend to peak on Saturday, in the summer months, in 1972 and 1973, and on holidays. Suicides are generally highest on Monday, in the spring months, in 1975 and 1976, and on nonholidays. Differentials in the temporal patterns are evident. For instance, whites generally have a sharper decline in suicides on holidays than do nonwhites. The holiday peak in MVF for the 60 and over population is Christmas, while it is New Year's for the younger age groups. Males exhibit a greater increase in suicides from March to May than do females. Finally, the results of a comparison of the daily patterns of MVF and suicides revealed a negative correlation. This contrasted with the strong positive relationship between MVF and suicides generally found in cross-sectional studies. The implications of these findings are briefly discussed. [ABSTRACT FROM AUTHOR]

It is difficult to obtain direct empirical estimates of chronic disease prevalence in the U.S. population. The available estimates are usually derived from epidemiological studies of selected populations. In this paper we present strategies for estimating morbidity distributions in the national population using auxiliary biomedical evidence and theory to estimate transitions to morbidity states from a cohort mortality time series. We present computational methods which employ these estimates of morbid state transitions to produce life table functions for both primary (morbidity) and secondary (mortality) decrements. These methods are illustrated using data on stomach cancer mortality for nine white male cohorts, aged 30 to 70 in 1950, observed for a 28-year period (1950 to 1977). [ABSTRACT FROM AUTHOR]

This paper investigates the importance of agricultural land shortages versus modernization of the society in influencing inter-state differentials in fertility in 1900, when the United States was in mid-transition. Urbanization and manufacturing characteristics of states were the strongest correlates of variations in the index of total fertility because urban-industrialism depressed both the probability of marriage and marital fertility. Other modern characteristics of American states were also important in understanding variations in marital fertility. Low labor force employment of children and farm mechanization, integrally related characteristics, seemed to depress levels of marital fertility in many parts of the United States, independent of the urban-industrial system. Agricultural land opportunity had little overall effect on marital fertility; however, it was quite important in understanding variations in patterns of marriage. [ABSTRACT FROM AUTHOR]